Abstract
Introduction
Open and arthroscopic hip debridement may be used for treatment of femoral acetabular impingement (FAI). There is a paucity of evidence regarding the efficacy of one over the other.
Aim
To compare survivorship in terms of further surgical procedure at five years, in patients having undergone either arthroscopic or open hip debridement.
Methods
Using our institutional database, we identified all post learning curve arthroscopic and open hip debridement cases with five years of follow up. Patients were matched based on age, gender and Tonnis grade. The primary outcome measure was 5 year survivorship to total hip arthroplasty (THA). Secondary outcome measures included 5 year survivorship to further (non THA) procedures on the joint. Radiological parameters were analysed including femoral neck version, sourcil, centre-edge and alpha angles.
Results
A total of 390 arthroscopic and 1316 open operations were identified. Following exclusion and matching 102 (62 female, 39 male) cases were available for analysis in each group. Mean age was 36 years (range 17–51). At 5 years 14.8% of arthroscopic debridement patients and 5.9% of open debridement patients had undergone THA (p =0 .038). There was no statistical difference in secondary outcome measures.
Discussion
A significantly higher percentage of patients undergoing arthroscopic debridement went on to THA when compared to matched patients receiving open debridement. We acknowledge the limitations of this study. However, despite the increasing prevalence of arthroscopic surgery to treat FAI, our results would suggest that open debridement may still remain the gold standard intervention. Further investigation, ideally in the form of an RCT, is warranted.
Conclusion
In our case matched series, despite the longer rehabilitation and greater soft tissue insult, open surgery for FAI was associated with significantly less patients progressing to THA within 5 years compared to those undergoing arthroscopic debridement.
